Scaling Up HIV Treatment for Men Who Have Sex with Men (MSM): What Does it Take?

A new study sheds light on how to halve the number of new HIV infections among men who have sex with men in Bangkok.

HIV and MSM in Thailand

  • Thailand has been hit hard by HIV. 440,000 people are living with HIV in Thailand and more than 1,200 people die each year from HIV-related causes.
  • Thailand has successfully curbed the spread of HIV among sex workers and their clients. Its 100% Condom Use Program is world-renowned.
  • However, its response to HIV among men who have sex with men (MSM) has been limited.
  • HIV prevalence among MSM has risen sharply from around 6% in the late 1990s to as much as 30% today, and continues to grow.
  • MSM account for over 40% of new HIV cases each year. This figure could go as high as 59% within the next 10 years, according to the Asian Epidemic Model estimate.

MSM in Metropolitan Bangkok

  • There are around 185,000 men who have sex with men living in metropolitan Bangkok, and 60,000 of whom are at high-risk of infection.
  • Of the high-risk group, only 14,000 men were tested, and 4,000 were diagnosed positive.
  • Yet fewer than 1,000 men who tested positive started taking anti-retroviral treatment (ART) medicine, despite being available for free.
  • There are enough clinics and health personnel in Bangkok to support testing and treatment for all MSM who need it.
  • Over 90 medical facilities in Bangkok could test and treat all MSM, yet they are left largely unused.
  • Over 75% of HIV testing and treatment is done in just two research clinics.
  • About 200,000 HIV tests are performed each year in Bangkok. Yet the medical facilities could perform an additional 400,000 tests each year. This means that more than 65% of HIV testing capacity goes unused each year.

What Does it Take?

  • Scaling up HIV testing and treatment services will not only save lives, it will also cut costs.
  • An additional $55 million investment over the next decade – just a moderate increase over current levels – will help achieve universal treatment coverage in Bangkok.
  • This could prevent over 5,000 HIV-related deaths and almost 4,000 new HIV cases (each year).
  • Public facilities/hospitals can test and treat men who have sex with men effectively and at the lowest cost.
  • They are the best tool to scale-up treatment among Bangkok’s MSM.
  • They can be made more effective by drawing on the successful experiences of research clinics that have created welcoming environments for patients with convenient hours and friendly staff.
  • Involving experts from research clinics and members of the MSM community in delivering HIV testing, treatment and prevention services will improve the overall quality of service.
  • Employing multiple recruitment methods will help connect MSM to HIV testing and treatment services.
  • For example, a peer follow-up system has been shown to be effective in helping MSM who test HIV positive get and sustain life-saving treatment so that they can live healthier and productive lives.